The petition shall be verified and shall state:
(a) The name and address of the petitioner;
(b) The facts as to domicile and residence;
(c) The date and place of birth;
(d) The birth certificate number, and place where the birth is registered, if registered;
(e) The name desired by petitioner;
(f) A clear and concise statement of the reasons for the desired change;
(g) A positive statement that the change is not sought for any illegal or fraudulent purpose, or to delay or hinder creditors.